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This is VAERS ID 631264

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2016

VAERS ID: 631264
VAERS Form:
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2016-04-08
Onset:2016-04-09
Submitted:2016-04-11
Entered:2016-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M51858 / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M37315 / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain, Rash erythematous, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness:
Preexisting Conditions: Hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Red, blotchy rash from elbow to shoulder. Extreme soreness.


Changed on 9/14/2017

VAERS ID: 631264 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2016-04-08
Onset:2016-04-09
Submitted:2016-04-11
Entered:2016-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M51858 / 1 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M37315 / 0 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain, Rash erythematous, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness:
Preexisting Conditions: Hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Red, blotchy rash from elbow to shoulder. Extreme soreness.


Changed on 2/14/2018

VAERS ID: 631264 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2016-04-08
Onset:2016-04-09
Submitted:2016-04-11
Entered:2016-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M51858 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M37315 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain, Rash erythematous, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness:
Preexisting Conditions: Hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Red, blotchy rash from elbow to shoulder. Extreme soreness.


Changed on 6/14/2018

VAERS ID: 631264 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2016-04-08
Onset:2016-04-09
Submitted:2016-04-11
Entered:2016-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M51858 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M37315 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain, Rash erythematous, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness:
Preexisting Conditions: Hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Red, blotchy rash from elbow to shoulder. Extreme soreness.


Changed on 8/14/2018

VAERS ID: 631264 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2016-04-08
Onset:2016-04-09
Submitted:2016-04-11
Entered:2016-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M51858 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M37315 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain, Rash erythematous, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness:
Preexisting Conditions: Hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Red, blotchy rash from elbow to shoulder. Extreme soreness.


Changed on 9/14/2018

VAERS ID: 631264 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2016-04-08
Onset:2016-04-09
Submitted:2016-04-11
Entered:2016-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M51858 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M37315 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain, Rash erythematous, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness:
Preexisting Conditions: Hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Red, blotchy rash from elbow to shoulder. Extreme soreness.


Changed on 10/14/2018

VAERS ID: 631264 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2016-04-08
Onset:2016-04-09
Submitted:2016-04-11
Entered:2016-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M51858 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M37315 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain, Rash erythematous, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness:
Preexisting Conditions: Hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Red, blotchy rash from elbow to shoulder. Extreme soreness.


Changed on 12/24/2020

VAERS ID: 631264 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2016-04-08
Onset:2016-04-09
Submitted:2016-04-11
Entered:2016-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M51858 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M37315 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain, Rash erythematous, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness:
Preexisting Conditions: Hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Red, blotchy rash from elbow to shoulder. Extreme soreness.


Changed on 12/30/2020

VAERS ID: 631264 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2016-04-08
Onset:2016-04-09
Submitted:2016-04-11
Entered:2016-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M51858 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M37315 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain, Rash erythematous, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness:
Preexisting Conditions: Hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Red, blotchy rash from elbow to shoulder. Extreme soreness.


Changed on 5/7/2021

VAERS ID: 631264 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2016-04-08
Onset:2016-04-09
Submitted:2016-04-11
Entered:2016-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M51858 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M37315 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain, Rash erythematous, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness:
Preexisting Conditions: Hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Red, blotchy rash from elbow to shoulder. Extreme soreness.


Changed on 5/21/2021

VAERS ID: 631264 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2016-04-08
Onset:2016-04-09
Submitted:2016-04-11
Entered:2016-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M51858 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M37315 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pain, Rash erythematous, Rash macular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness:
Preexisting Conditions: Hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Red, blotchy rash from elbow to shoulder. Extreme soreness.

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